This study is a trial to conform a rational approach to the appropriate management of renal trauma, as the rate of renal trauma is  increasing due to the increase in the human activities. It included 32 patients presented at the causality unit of Assiut University Hospital over a Period of 1.5 year, from January 1992 to June 1993. Blunt trauma was the commonest cause, 23 patients (71.9%).
Penetrating injury was encountered in 9 patients (28.9%) (6 firearm and 3 stab wounds).

Hematuria was the commonest symptoms, it was absent in one Patient, which proved to be renal artery thrombosis on exploration.

All patients after a thorough clinical examination and resuscitation were subjected to ultrasonographic evaluation and 27 patients (84.4%) were evaluated by I.V.U.

Twelve patients with minor blunt renal trauma were successfully treated with conservative means with no sequalae, except minimal renal scarring in two patients as detected by IVU.

In the follow up period.

Eleven patients with major renal trauma were treated by early surgical intervention. Nine injured kidneys could be saved, while nephrectomy was done in only two patients with pedicle injury. No sequalae or complications were encountered in patients with major renal injuries who were treated by early surgical intervention.

Nine patients with major renal injuries were surgically explored at a later date as a consequence of conservative treatment. Repair was carried out in only three cases. While three polar nephrectomies were indicated. Three injured kidneys were scarified.

The average hospital stay for non-surgically treated group was 10 days and for the surgically treated group was 12 days in case of absence of associated injuries. In those with associated it approached about three weeks.

Conclusion:

Trauma accounts for the majority of deaths in both men and women under forty years of age. Approximately ten percent of injuries involve the genitourinary tract, most commonly the kidney. The majority of renal injuries are secondary to blunt trauma, which
is more common than penetrating injuries. Hematuria is the most common sign of renal trauma, when present it is suggestive of potential renal injury, although its degree does not
correlate with the severity of trauma, absence of hematuria does not exclude renal injury.

Proper management of renal injuries is based on early and complete
utilization of all diagnostic facilities necessary to accurately determine
the extent of the injury. Intravenous urography and ultrasonography are
very useful tools in evaluation of renal trauma cases, however CT scan is
the best method to define the injury and to confirm the coincidence of associated major organ injuries.

All patients with penetrating renal trauma should undergo immediate surgical intervention when they are haemodynamically stable, as any
delay could be associated with several urologic problems or even renal
loss. Also early surgical intervention is indicated in all cases with major
blunt renal traumata. With proper surgical drainage, repair of parenchymal and collecting system tears, a high rate of renal salvage without complications or sequalae could be safely obtained. Minor blunt renal injuries could be successfully treated by conservative means.

Follow up imaging study should be obtained in reconstructed kidneys.
Renal scan provide functional data and intravenous urography gives
anatomic information. With careful follow up most renal injuries could
have an exce